Gómez RBJ, Romero CR,Hergueta DPH, Pellicer BFJ, Herrerías GJM

Language: Spanish
References: 26
Page: 201-206
PDF size: 117.08 Kb.

ABSTRACT

The diagnosis of the small bowel’diseases is based on the radiology (bowel transit with Barium, enteroclysis, ultrasonography, angiography, axial tomography, nuclear magnetic resonance), enteroscopy and surgery. In the last years an important advance has taken place in the vision of the structures of the small intestine, with the improvement of the nuclear magnetic resonance and the wireless endoscopy. Enteroscopy has a moderate performance, finding lesions in 23% of the cases in a global way. According to the indication there are findings in 42,8% of the cases occult digestive bleeding, in 24% of chronic diarrhoea and in 10% in abdominal pain. The best results are obtained in the study of the occult digestive haemorrage (that can appear as syderopenic anaemia for losses or frank digestive haemorrhage), identifying up to 58% of the bleeding points. It can even discover 23% of the gastroduodenal bleeding lesions that have not been discovered with the conventional high digestive endoscopy. Previous studies comparing wireless endoscopy and enteroscopy in the identification of small intestinal lesions have shown that the sensibility was of 64% in wireless endoscopy, while it was of 37% in enteroscopy. The specificity was similar with both techniques being around 95%. Although the wireless endoscopy is able to discover a higher number of lesions, it does not allow to study their histology and cannot be used if there exists suspicion of a stenosis. To summarize, we can conclude that this technique is useful in the study of diarrhoea and malabsorption, in the always difficult study of occult digestive haemorrhage, to estimate the extension of the Crohn’s disease and to discard or confirm radiological abnormalities. It should be used as a screening of intestinal lesions in the syndromes of hereditary polyposis and it is of scarce or null value to study patient with abdominal pain. The enteroscopic biopsy increases diagnostic accuracy and samples of the intestine for histological study should always be taken in patients undertaking endoscopic exploration.

REFERENCES

1. Sharma BC, Bhasin DK, Makhasia G. Diagnostic value of push-type enteroscopy: A report from India. Am J Gastroenterol 2000; 95: 137-140.

2. Banai J, Szanto I. Endoscopic diagnosis of gastrointestinal bleeding of unknown origin. Magy Seb 2001; 54: 155-157.

3. Appleyard M, Fireman Z, Glukhovsky A. A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small bowel lesion. Gastroenterology 2000; 129: 1431-1438.

4. Lewis BS. Small intestinal bleeding. Gastroenterol Clin North Am 2000; 29: 67-95.

5. Amaro R, Barkin JS. Diagnostic and therapeutic options in obscure gastrointestinal blood loss. Curr Gastroenterol Rep 2000; 2: 395-398.

6. Hayat M, Axon AT, O’Mahony S. Diagnostic yield and effect on clinical outcomes of pus enteroscopy in suspected small-bowel bleeding. Endoscopy 2000; 32: 369-372.

7. Van Gossum A. Obscure digestive bleeding. Bailleres Best Pract Res Clin Gastroenterol 2001; 15: 155-174.

8. Soderman C, Uribe A. Enteroscopy as a tool for diagnosing gastrointestinal bleeding requiring blood transfusion. Surg Laparosc Endos Percutan Tech 2001; 112: 97-102.

9. Sharma Bc, Bhasin DK, Bati HS. Gastrointestinal bleeding due to worm infestation, with negative upper gastrointestinal endoscopy findings: impact of enteroscopy. Endoscopy 2000; 32: 314-316.

10. Douard R, Wind P, Parris Y. Intraoperative enteroscopy for diagnosis and management of unexplained gastrointestinal bleeding. Am J Surg 2000; 180: 181-184.

11. Marshall JK, Levi OA, Hunt RH. Obscure gastrointestinal bleeding: An approach to management. Can J Gastroenterol 2000; 14: 111-118.

12. Grosbois B, Gatel A. Diagnosis and treatment of iron deficiency. Rev Prat 2000; 50: 966-971.

13. Schilling D, Grieger G, Weidman E. Long-term follow-up of patients with iron deficiency anemia after a close endoscopic examination of the upper and lower gastrointestinal tract. Z Gastroenterol 2000; 38: 827-831.

14. Murray JA, Smith JA, Cupland K. Intestinal disaccharidase deficiency without villous atrophy may represent early celiac disease. Scand J Gastroenterol 2001; 36: 162-168.

15. Pennazio M, Ronini FP. Small-bowel polyps in Peutz-Jeghers syndrome: Management by combined push enteroscopy and intraoperative enteroscopy. Gastrointest Endos 2000; 51: 304-308.

16. Yoshida Y, Endo T, Saraki T. Jejunal carcinoid tumor mimicking leiomyosarcoma: Preoperative diagnosis by endoscopic biopsy. J Gastroenterol 2001; 36: 39-43.

17. Ugwonali O, Coady M, Saxera R. Intraoperative enteroscopy for diagnosis of a bleeding jejunal lymphangioma. J Clin Gastroenterol 2000; 31: 333-335.

18. Dieter RS, Duque K. Enterotherapy associated T-cell lymphoma: a case report and literature review. WMJ 2000; 99: 28-31.

19. Sugar I, Szabo S, Joos A. Acute gastrointestinal bleeding cause by a rare, benign tumor of the duodenum (gangliocystic paragangliomas). Magy Seb 2000; 53: 279-282.

20. Taylor AC, Allen RM, Buttigleg RJ. Jejunal ulceration and push enteroscopy. Lancet 2000; 356: 2192-2193.

21. Rossini FP, Pennazio M. Small-bowel endoscopy. Endoscopy 2000; 32: 238-245.

22. Burak KW, May GR. C1-inhibitor deficiency and angioedema of the small intestine masquerading as Crohn’s disease. Can J Gastroenterol 2000; 14: 349-351.

23. Gostout CJ, Bender CE. Cholangiopancreatography, sphineterotomy, and common duct stone removal via Roux-en-Y limb enteroscopy. Gastroenterol 1988; 95: 156-163.

24. Cheng Q. Remission of abdominal colic during enteroscopy by injecting vitamin K3 into Zusanli acupoint. J Tradit Chin Med 2000; 20: 271-272.

25. Lewis MP, Khoo DE, Spencer J. Value of laparotomy in the diagnosis of obscure gastrointestinal haemorrhage. Gut 1995; 37: 187-190.

26. Perez Cuadrado E, Molina Perez E. Multiple strictures in jejunal Crohn’s disease; push enteroscopy dilatation. Endoscopy 2001; 33: 194.